<!DOCTYPE html>
<html lang="zh-CN">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <meta http-equiv="X-UA-Compatible" content="ie=edge">
    <link rel="stylesheet" href="https://cdn.staticfile.org/font-awesome/5.15.3/css/all.min.css">
    <link rel="stylesheet" href="https://cdn.staticfile.org/bootstrap/5.0.1/css/bootstrap.min.css">
    <title>预约问诊记录单</title>
    <style>
        body {
            background-color: #f0f2f5;
        }
        .card {
            border-radius: 10px;
            margin: 20px;
            box-shadow: 0 0 20px rgba(0,0,0,0.1);
        }
        .card-header {
            border-radius: 10px 10px 0 0;
            background-color: #007bff;
            color: #fff;
        }
        .form-label {
            font-weight: 500;
        }
        .form-input {
            padding: .375rem .75rem;
            line-height: 1.5;
            background-color: #fff;
            border: 1px solid #ced4da;
            border-radius: .3rem;
        }
        .form-radio {
            padding-left: .5rem;
        }
        .form-check-label {
            font-weight: 500;
        }
        .form-select {
            padding: .375rem .75rem;
            line-height: 1.5;
            background-color: #fff;
            border: 1px solid #ced4da;
            border-radius: .3rem;
        }
        .form-text {
            font-size: 80%;
        }
        .btn-cancel {
            background-color: #ff5050;
            border-color: #ff5050;
        }
        .btn-cancel:hover {
            background-color: #e00000;
            border-color: #e00000;
        }
        .status-label {
            border-radius: 10px;
            padding: 5px 10px;
            font-weight: 500;
        }
        .status-success {
            background-color: #28a745;
            color: #fff;
        }
        .status-warning {
            background-color: #ffc107;
            color: #212529;
        }
        .status-danger {
            background-color: #dc3545;
            color: #fff;
        }
        .status-pending {
            background-color: #007bff;
            color: #fff;
        }
        .queue-label {
            border-radius: 10px;
            padding: 5px 10px;
            font-weight: 500;
            background-color: #007bff;
            color: #fff;
        }
    </style>
</head>
<body>
    <div class="container mt-5">
        <div class="card">
            <div class="card-header">
                <h4 class="mb-0">预约问诊记录单</h4>
            </div>
            <div class="card-body">
                <div class="row mb-3">
                    <label for="input-name" class="col-sm-2 col-form-label form-label">病人姓名</label>
                    <div class="col-sm-4">
                        <input type="text" class="form-control form-input" id="input-name" value="张三" readonly>
                    </div>
                    <label for="input-phone" class="col-sm-2 col-form-label form-label">病人电话</label>
                    <div class="col-sm-4">
                        <input type="tel" class="form-control form-input" id="input-phone" value="138****8888" readonly>
                    </div>
                </div>
                <div class="row mb-3">
                    <label for="input-id" class="col-sm-2 col-form-label form-label">身份证号</label>
                    <div class="col-sm-4">
                        <input type="text" class="form-control form-input" id="input-id" value="330****19820214" readonly>
                    </div>
                    <label for="input-gender" class="col-sm-2 col-form-label form-label">病人性别</label>
                    <div class="col-sm-4">
                        <input type="text" class="form-control form-input" value="男性" readonly>
                    </div>
                </div>
                <div class="row mb-3">
                    <label for="input-doctor" class="col-sm-2 col-form-label form-label">检查医生</label>
                    <div class="col-sm-4">
                        <input type="text" class="form-control form-input" value="李四" readonly>
                    </div>
                    <label for="input-room" class="col-sm-2 col-form-label form-label">诊室</label>
                    <div class="col-sm-4">
                        <input type="text" class="form-control form-input" value="A101" readonly>
                    </div>
                </div>
                <div class="row mb-3">
                    <label for="input-time" class="col-sm-2 col-form-label form-label">预约时间</label>
                    <div class="col-sm-4">
                        <input type="text" class="form-control form-input" value="2023-06-01 08:30" readonly>
                    </div>
                    <label for="input-queue" class="col-sm-2 col-form-label form-label">排队序号</label>
                    <div class="col-sm-4">
                        <input type="number" class="form-control form-input" value="12" readonly>
                    </div>
                </div>
                <div class="row mb-3">
                    <label for="input-queue" class="col-sm-2 col-form-label form-label">预计等待时间</label>
                    <div class="col-sm-4">
                        <input type="text" class="form-control form-input" value="20 分钟" readonly>
                    </div>
                    <label for="input-status" class="col-sm-2 col-form-label form-label">预约状态</label>
                    <div class="col-sm-4">
                        <span class="status-label status-warning">待就诊</span>
                    </div>
                </div>
                <div class="row mb-3">
                    <div class="col-sm-4 offset-sm-2">
                        <button type="button" class="btn btn-danger btn-cancel">取消预约</button>
                    </div>
                    <div class="col-sm-4">
                        <button type="button" class="btn btn-success">签到</button>
                    </div>
                </div>
            </div>
        </div>
    </div>
</body>
</html>